Mental health inequalities in detecting breast cancer

Women with a mental illness (including depression, anxiety, and serious mental illnesses) are less likely to be screened for breast cancer, according to new research.

The study was led by Alex J. Mitchell, MD, consultant psychiatrist in the Department of Cancer Studies at the University of Leicester in the United Kingdom. It was published in the British Journal of Psychiatry (2014; doi:10.1192/bjp.bp.114.147629).

Studies have previously shown there is a higher mortality rate due to cancer in people with mental illness, perhaps because of high rates of risk factors such as smoking. In addition, it appears cancer is often detected later in those with mental illness.

Previous research has shown that people with mental illness receive suboptimal medical care. An important question is whether women with a mental illness are less likely to be screened for breast cancer than those who do not have mental health issues. Could the diagnosis of a mental health condition prejudice receipt of a screening mammogram?

To find out more, UK-based researchers from the Universities of Leicester and Greenwich reviewed 24 publications reporting breast cancer screening practices in women with mental illness (approximately 700,000), and five studies investigating screening for those in distress but who did not have a mental illness diagnosis (nearly 21,500).

Researchers found that there were significantly reduced rates of mammography screening in women with mental illness, depression, and severe mental illness such as schizophrenia. The effect was not present in women with distress alone, suggesting distress was not the explanation.

"We have previously shown that there are inequalities in medical care for people who happen to have a mental health diagnosis. This is partly explained by poorer attendance but also partly explained by willingness of staff to treat a patient's medical condition at the same time as a mental health condition,” said Mitchell.

“In this study we found that mental ill health was linked with 45,000 missed screens which potentially could account for 90 avoidable deaths per annum in the UK alone. Clearly patients with mental illness should receive care that is at least comparable with care given to the general population. Every effort should be made to educate and support women with mental illness called for screening."